(Solved) NRNP6566 Advanced Care of Adults in Acute Settings I | Homework Solution

NRNP6566 Advanced Care of Adults in Acute Settings I Week 1 Discussion: Impact of Pharmacokinetics on Medication Selection and Administration

As an advanced practice nurse, you will likely be responsible for selecting and prescribing pharmaceuticals to address your patients’ health needs and concerns. To what extent is understanding the pharmacokinetics of a certain medication important in your decision-making process when prescribing a medication for your patient?

Knowing the pharmacokinetic effects of medications—such as how long will the medication be absorbed and exert an effect on the body before it is eliminated—can have important implications for addressing your patient’s health needs.

For this Discussion, think about the types of decisions you might make, with an understanding of pharmacokinetics, when prescribing medications for your patients. Reflect on how having a working knowledge of pharmacokinetics of medications is important in your role as an advanced practice nurse.

NRNP6566 Advanced Care of Adults in Acute Settings I Week 2 Assignment Branching Exercise: Cardiac Case 1

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

To prepare:

Review the interactive media piece/branching exercise provided in the Learning Resources.

Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.

Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.

You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

Be sure to address each aspect of the order template

Write the orders as you would in the patient’s chart

Make sure the order is complete and applicable to the patient

Any rationale you feel the need to supply should be done at the end of the order set – not included with the order

Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.

A minimum of three current, evidenced-based references are required.

By Day 7 of Week 2

Submit your completed Assignment by Day 7 of Week 2 in Module 2.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following: NRNP6566

• Please save your Assignment using the naming convention “MD2Assgn1+last name+first initial.(extension)” as the name.
• Click the Module 2 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Module 2 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD2Assgn1+last name+first initial.(extension)” and click Open.

If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. Click on the Submit button to complete your submission.

NRNP6566 Advanced Care of Adults in Acute Settings I Week 4 Assignment Branching Exercise: Cardiac Case 2

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

To prepare:

Review the interactive media piece/branching exercise provided in the Learning Resources. Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.

Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.

You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

Be sure to address each aspect of the order template

Write the orders as you would in the patient’s chart

Make sure the order is complete and applicable to the patient

Any rationale you feel the need to supply should be done at the end of the order set – not included with the order

Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.

A minimum of three current, evidenced-based references are required.

Please save your Assignment using the naming convention “MD2Assgn2+last name+first initial. NRNP6566 (extension)” as the name.

• Click the Module 2 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
• Click the Module 2 Assignment 2link. NRNP6566 You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD2Assgn2+last name+first initial. (extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

NRNP6566 Advanced Care of Adults in Acute Settings I Week 9 Assignment Branching Exercise: Common Diseases and Disorders

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

To prepare:

• Review the interactive media piece/branching exercise provided in the Learning Resources.
• Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.
• Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.
• You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise. NRNP6566 Be sure to address each aspect of the order template.

Write the orders as you would in the patient’s chart.

Make sure the order is complete and applicable to the patient.

Any rationale you feel the need to supply should be done at the end of the order set – not included with the order.

Please do not write per protocol. NRNP6566 We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.

A minimum of three current, evidenced-based references are required.

Please save your Assignment using the naming convention “MD5Assgn+last name+first initial.(extension)” as the name.

Click the Module 5 Assignment Rubric to review the Grading Criteria for the Assignment.

Click the Module 5 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “MD5Assgn+last name+first initial.(extension)” and click Open.

If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. Click on the Submit button to complete your submission.

NRNP6566 Advanced Care of Adults in Acute Settings I Week 3 Knowledge Check

Question 1: What is your interpretation of this 12-lead EKG? NRNP6566

Question 2: A 66-year-old female complains of dizziness, fatigue, and shortness of breath. Her EKG is below. What is your working diagnosis? What immediate treatment is indicated?

Question 3: A 59-year-old male complains of dizziness, palpitations, weakness, and chest tightness. These symptoms have occurred a couple times a day for the last seven days. NRNP6566 EKG shows atrial fibrillation with rapid ventricular response. His blood pressure varies with readings of 90/42 to 120/66. Heart rate ranges from 150—210.   The decision is made to cardiovert the patient. Prior to the procedure, what testing is essential to complete?

Question 4: A 58-year-old male complains of a galloping heart rate and shortness of breath. Vital signs are BP 110/74, P 156, RR 22 Oxygen sat is 96%. Continuous EKG monitoring identifies periods of sinus tachycardia as well as episodes of atrial fibrillation. Laboratory results for this patient show: NRNP6566

Hemoglobin 13.3 g/dl Hematocrit 39% WBC 8.7 Platelets 172,000 Sodium 140 Potassium 3.7 TSH 0.0 mIU/L T4 3 mg/dl T3 6.6 pg/ml

What is your working diagnosis and what two initial medications would you prescribe for this patient?

Question 5: What is your interpretation of this 12-lead EKG?

NRNP6566 Advanced Care of Adults in Acute Settings I Week 4 Knowledge Check

Question 1: A 56-year-old man is thought to be in hypovolemic shock. What physical assessment findings would you expect to find to confirm this type of shock?

Question 2: A 56-year-old Caucasian man is seen in the office as a new patient. He complains of headaches occurring with increasing frequency and attributes them to increased stress at work. He denies any chest pain, shortness of breath, or dyspnea. He smokes one pack of cigarettes per day and has two glasses of wine with dinner. NRNP6566 Physical exam – obese main (BMI 30) in no apparent distress. BP R arm 168/98 L arm 170/94. HR 64 regular.

No thyromegaly or lymphadenopathy. Fundascopic exam reveals narrowing of the arteries and arteriovenous nicking. A cardiac exam reveals that his point of maximal impulse (PMI) is displaced 2 cm to the left of the midclavicular line (MCL). NRNP6566 No murmurs noted. Lung and abdomen examinations are normal. What tests should be ordered for this patient?

Question 3: A 44-year-old man is thought to be in cardiogenic shock. What are the initial interventions needed for a patient in cardiogenic shock?

Question 4: What is the mechanism of action and common side effects of dobutamine, norepinephrine, labetalol, and amiodarone?

Question 5: What is the difference between dopamine and dobutamine?

NRNP6566 Advanced Care of Adults in Acute Settings I Week 5 Knowledge Check

Question 1: A 26-year-old male was injured in a motorcycle crash 3 days ago. He sustained an acute subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury and resulting paralysis. He has a warm swollen right lower leg. Duplex ultrasound of the right lower leg is positive. What is the best treatment for this patient?

Question 2: A 66-year-old man is taking warfarin due to his atrial fibrillation. He noted that his gums were bleeding yesterday while eating. Today he had a coughing spell and has been spitting up bright red blood ever since. The APRN is called by the ER with the result of the INR ordered. The INR is 9.8. NRNP6566 What is the appropriate treatment of this patient?

Question 3: A 66-year-old man was evaluated for shortness of breath for the last three months. Diagnostic work up confirmed a pulmonary embolism. He is alert and oriented. Vital signs are stable. He is ambulatory. He has a stable home environment and good support from his wife. NRNP6566 He is on day 2 of treatment with Lovenox 90 mg every 12 hours. The patient wants to go home. Would you discharge him? How would you manage his medications?

Question 4: Renee is a 56-year-old female that fell about a week ago and sprained her R ankle. She states she has been taking it easy and laying around her home for most of the last week so it would heal. Yesterday she noticed that her calf was sorer than it had been, and her R foot and ankle were more swollen than they had been. She came to urgent care today because she was afraid that the injury was worse than she thought it was.

T 99.2 BP 128/77 HR 88 RR 18 Wt 126 pounds Heart S1S2 regular rate and rhythm, Lungs clear, Abdomen soft R ankle is swollen but not discolored. 1-2+ edema noted Dorsiflexion causes some discomfort in the ankle and calf area. Pedal pulses equal bilaterally The APRN orders a duplex ultrasound of the right leg. NRNP6566 Radiology reports that the ultrasound is positive for deep vein thrombosis. How would you manage this patient (include labs and meds)?

Question 5: A 64-year-old man diagnosed with a pulmonary embolism is currently on warfarin. His INR readings have been very inconsistent, and the decision is made to change his medication to Rivaroxaban (Xarelto). What dose should be initiated and how would you discontinue the warfarin?

NRNP6566 Advanced Care of Adults in Acute Settings I Week 7 Knowledge Check 1

Question 1: For the following ABGs, identify the level of hypoxemia, the primary acid-base disorder, and the type of compensation. Example – acute respiratory acidosis with metabolic alkalosis and severe hypoxemia ABG Result pH          pCO2     pO2        HCO3 7.08        54           54           15 NRNP6566

Question 2: A 14-year-old female asthmatic is brought to the ER in moderate respiratory distress. Her PEF is 55% of predicted. What would your immediate medication orders include?

Question 3: For the following ABGs, identify the level of hypoxemia, the primary acid-base disorder, and the type of compensation. Example – acute respiratory acidosis with metabolic alkalosis and severe hypoxemia ABG Result pH          pCO2     pO2        HCO3 7.51        39.4        77.3        31.3 NRNP6566

Question 4: For the following ABGs, identify the level of hypoxemia, the primary acid-base disorder, and the type of compensation. Example – acute respiratory acidosis with metabolic alkalosis and severe hypoxemia ABG Result pH          pCO2     pO2        HCO3 7.36        30           80           15

Question 5: A 23-year-old male with Type 1 diabetes presents to the ER complaining of fatigue and malaise. He tells you he has skipped his insulin injections the previous two days. His labs are: NRNP6566 PH          7.10        Na          140         BUN       35 PCO2     10           K             4.1          Crt          1.1 PO2        112         Cl            105         BS           845 HCO3     4              CO2           5           + ketonemia

What is this patient’s acid-base status? What is your working diagnosis for this patient

NRNP6566 Advanced Care of Adults in Acute Settings I Week 8 Knowledge Check

Question 1: The APRN has determined that a 21-year-old motor vehicle crash victim needs a rapid sequence intubation. The patient weighs 77 kg. What medications are indicated to successfully achieve the rapid sequence intubation?

Question 2: A 13-year-old girl is evaluated in urgent care for a large wound on her left forearm. She complains of severe pain, is crying, and is rocking on the bed due to pain. The APRN is planning on how to repair the laceration and is considering utilizing ketamine for procedural sedation. NRNP6566 What are the benefits and risks of this drug? What monitoring would be indicated if utilized?

Question 3: A 44-year-old man was given fentanyl to achieve moderate sedation for a colonoscopy. During the procedure, the patients oxygen saturation begins to decline and while assessing the patient the NP notices chest wall rigidity. NRNP6566 What is the cause of the rigidity and how would you treat it?

Question 4: What type of ICU sedation would be appropriate for a 32-year-old male patient who is intubated with bilateral chest tube following a motor vehicle crash.

Question 5: A 77-year-old man fell and suffered a laceration across his upper right lip. The APRN decides to utilize a block for pain control which suturing the laceration. What type of block and what medication would be appropriate for this patient?

NRNP6566 Advanced Care of Adults in Acute Settings I Week 9 Knowledge Check

Question 1: A 16 year old male is admitted to the step down unit following laparotomy for appendici-tis. It was determined during surgery that the appendix had ruptured causing a perito-nitis. NRNP6566 What antibiotics would be indicated to treat the peritonitis?

Question 2: This is a sensitivity report for a 45 year old male. NRNP6566 What antibiotic would you not order to treat this infection? Would ciprofloxin with a MIC of 1 be more effective than aztreonam with a MIC of 8?

Question 3: A 42-year-old female has a severe bacterial infection. She is being treated with a broach spectrum IV drug. The drug is administered too rapidly causing hypotension, flushing and itching over the upper portion of her chest, neck, and face. What antibiotic is likely responsible for these symptoms?

Question 4: A 42-year-old man is evaluated for redness, pain, swelling, and tenderness on the anterior right thigh. His symptoms started about 4 days ago with a small 1 cm blister on his thigh. The area has gotten bigger over the past 4 days and is now 4 cm x 6 cm. He indicates that has been having fever and chills over the past couple of days. The NP diagnoses him with cellulitis. What would your treatment for this be?

Question 5: A 52-year-old female is 7 days post lumbar laminectomy complaining of abdominal pain and severe diarrhea. She is afebrile with stable vital signs. NRNP6566 Lab results show a positive C-diff culture. How should you treat this patient?

NRNP6566 Advanced Care of Adults in Acute Settings I Week 10 Knowledge Check

Question 1: An 87-year male is brought to the emergency department from a nursing home by his family with concerns about his functional status. They state that over the past week he is very somnolent and not participating in his own care very much. The family is worried that he has had a stroke or is overmedicated by the nursing home staff. Medical record from the nursing home shows that he is disruptive and has daily wrist restraints ordered.

The patient is arousable but somnolent when no one is speaking with him. His past medical history is unremarkable. He was placed in the nursing home due to his age and inability to care for himself at home. His family states that he is usually quite alert and interactive.

The patient is widowed and has been at the nursing home for about 2 months. He has no routine medications but several PRN mediations including haloperidol, valium, and milk of magnesia. BP 100/53 T 98.3 HR 88 RR 14 Mucous membranes are dry. Pulmonary, cardiovascular, abdominal, and extremity examinations are normal. Chest x-ray shows no infiltrate and voided urine shows no evidenced of UTI. NRNP6566 LAB DATA: -Sodium 162 -Potassium 3.4 -Chloride 130 -Bicarbonate 23 -BUN 38 -Creatinine 1.8 -Glucose 97 -Calcium 10.3 What is your working diagnosis for this patient? How would you treat it?

Question 2: A 70-year-old man is 4 hours post right heme-colectomy for a tumor. The NP is called due to falling urine output since surgery. Past medical history – hypertension, type 2 diabetes, gout Medications – lisinopril, allopurinol, and spironolactone (all last given this morning). Physical exam – BP 100/60. HR 110 regular weight 60 kg Lungs are clear, abdominal wound is clean with no drainage, NRNP6566 No JVD Urine output 1700 hr. 35 ml 1800 hr 22 ml 1900 hr 15 ml 2000 hr. 8 ml Urine dipstick is normal How would you classify his renal status? How would you treat it?

Question 3: A 25-year-old man with schizophrenia is admitted to the psych unit for medication stabilization. The patient is responsive but sleepy. Vital signs are within normal limits and muscle tone is normal. The patient has a large container of sweet iced tea which is nearly empty. His admission labs include: -Sodium 122 -Potassium 4.0 -Chloride 101 -Bicarbonate 21 -BUN 67 -Creatinine 0.9 -Glucose 91 What is our working diagnosis? How would you treat it?

Question 4: A 44-year-old female is NPO following surgery for a bowel obstruction. She weighs 166 pounds. How would you calculate her daily maintenance IV fluid need while she is NPO?

Question 5: A 57-year-old female is admitted to the oncology unit for chemotherapy related to her to acute leukemia. Her initial dose of chemo was 2 days ago. While rounding today, NRNP6566 the patients tells the NP that she feels so weak. The NP notes her heart rate is 44 today (down from 68 2 days ago).

She has had less than 100 cc of urine out over the last 24 hours. Labs from this morning include: LAB DATA: -Sodium 131 -Potassium 7.8 -Chloride 105 -Bicarbonate 17 -BUN 67 -Creatinine 5.8 -Glucose 83 -Calcium 7.6 -Phosphorus 6.8 -Uric acid 16.3 What is your working diagnosis for this patient? How would you treat her?

NRNP6566 Advanced Care of Adults in Acute Settings I Week 11 Knowledge Check

Question 1: Juan is a 42-year-old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, NRNP6566 HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS  94/64   P 112  RR 30  T  99.4   wt 195 pounds  ht 5’11 »

Lungs clear bilaterally, rapid respiration CV :   RRR, no murmurs or gallops Abd:  soft, non-tender, positive bowel sounds Labs: Hb  146    Hct  58%   Cr  4.9   Bun  53    Cholesterol  238 Na  126  K  5.6  CL 95    Ca  8.8   Gluc 722  Phosphorus 5.8 Ketone  Moderate  AST  248  Alk Phos  132 ABG’s ph  7.01              Pco2  20              Po2  100              Sat    98% (on room air)              HCO3   7.5  What is the “ corrected” sodium level for the hyperglycemia? What does this mean and how would it impact your treatment plan for this patient?

Question 2: Juan is a 42-year-old male with complaints of nausea and vomiting for 3 days and has been unable to keep anything down in that time. He has not taken any of his medications due to the nausea and vomiting. Your assessment reveals the following data: Significant History Type 2 DM x 4 years, HTN Medications Lisinopril 10 mg daily Metformin 1000 mg po daily Glipizide 5 mg po daily Physical Exam Pale, lethargic gentleman Skin is very dry VS  94/64   P 112  RR 30  T  99.4   wt 195 pounds  ht 5’11 » NRNP6566 Get The Nature of News Essay Help!!

Lungs clear bilaterally, rapid respiration CV :   RRR, no murmurs or gallops Abd:  soft, non-tender, positive bowel sounds Labs: Hb  146    Hct  58%   Cr  4.9   Bun  53    Cholesterol  238 Na  126  K  5.6  CL 95    Ca  8.8   Gluc 722  Phosphorus 5.8 Ketone  Moderate  AST  248  Alk Phos  132 ABG’s ph  7.01              Pco2  20              Po2  100              Sat    98% (on room air)              HCO3   7.5  What patient education would be important to provided related to sick day management of his diabetes (include management of insulin) ?                                            \

Question 3: A 44-year-old female with history of type 2 diabetes taking metformin is admitted to the ICU following percutaneous placement of two coronary stents. Her chest pain is completely resolved. Twelve hours after the procedure the NP is contacted by the ICU nurse. NRNP6566 The patient is experiencing shortness of breath, severe muscles pain, chilled, and a slow irregular heartbeat. The patients ankles are swollen. The most recent labs show a Bun of 44 and Cr of 3.1. What do you suspect is happening with this patient?

Question 4: A 37-year-old female with a 20 year history of DM is post cholecystectomy with complications. She has been on four time daily blood sugar testing with sliding-scale insulin coverage. She is preparing for discharge and wanted to return to her previous blood sugar management. Her pre-hospitalization insulin regime included:                 NPH insulin 16 units in AM and 8 units in PM

Regular insulin 8 units in am and 3 units in PM She resumed this regime 2 days ago. Upon rounding this am, the patient tells the NP that she has woken up feeling awful. She is sweaty and shaky during the night and lethargic in the morning. The NP reviews her blood sugar readings and discovers this: 0300       0700       1200       1700       2100 62           196         109         90           146 64           203         82           100         150 NRNP6566 What is your working diagnosis for this patient?

Question 5: How would you differentiate between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)?